The Takeda Patient Assistance Program (PAP) provides patients with access to medications
for a variety of conditions.
CAN I APPLY?
- 1. You are a legal resident of the United States. You must live
in the United States and for some assistance programs must provide proof of residency
with either a Social Security Number, Green Card Number or Visa Number.
- 2. You do not have prescription coverage through private or government programs.
- 3. If you are eligible for, or enrolled in, Medicare Part D, you may still apply – see Sections 4 and 5 of the application form for guidelines.
- a. Attach a copy of the Social Security Low Income Subsidy (LIS) denial letter, if applicable.
-
b. Applicants will be referred when income is less than 135% of
Federal Poverty
Level
(FPL) guidelines.
- c. For further information, applicants can refer to www.socialsecurity.gov or may call 1-800-772-1213 (TTY 1-800-325-0778).
- 4. Your total
household incomeYour yearly household income includes
all money that comes into your household. If you are married and live with your
spouse, you must include both of your incomes. You must also include income earned
by dependents living with you. does not exceed:
| Persons in Household |
Annual Income |
| 1 |
$32,670 |
| 2 |
$44,130 |
| 3 |
$55,590 |
| 4 |
$67,050 |
| 5 |
$78,510 |
Takeda Medicines Available through the Patient Assistance Program
MEDICATION (generic)
ACTOS, ACTOplus met, ACTOplus met XR, duetact, EDARBI and Rozerem are trademarks
of Takeda Pharmaceutical Company Limited registered with the U.S. Patent and Trademark
Office and used under license by Takeda Pharmaceuticals America, Inc.
AMITIZA is a trademark of Sucampo Pharmaceuticals, Inc. registered with the U.S. Patent
and Trademark Office and used under license by Takeda Pharmaceuticals America, Inc.
DEXILANT is a trademark of Takeda Pharmaceuticals North America, Inc., registered in the U.S. Patent
and Trademark Office and used under license by Takeda Pharmaceuticals America, Inc.
ULORIC is a trademark of Teijin Pharma Limited registered with the U.S. Patent
and Trademark Office and used under license by Takeda Pharmaceuticals America, Inc.
This program, as well as all Takeda Pharmaceuticals America, Inc. programs, can be discontinued
or changed at any time without notice at the discretion of Takeda Pharmaceuticals America, Inc.